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Issue 12 â€˘ June 2012
FEATURES 04 Scrubs and Online Physician Ratings Krish Suresh
06 Being Pre-Med Dani Alcorn
09 Shared Savings, Shared Progress? Savan Patel
10 We are Young. Zach Snow
12 Medical School Curriculums Nirali Shah
14 Giving Voices to the Voiceless Alex Pezeshki
16 The MCAT as a Mirror Sarah Smith
2 • The Designfreebies Magazine Phi • www.designfreebies.org Medical Decoder Delta Epsilon Il Gamma
FROM THE EDITORS Welcome to the first edition of the Medical Decoder. The articles in this journal have been created by the members of Phi Delta Epsilon IL Gamma, Northwestern’s chapter of the international medical fraternity. As students, we are constantly inundated with classes, extracurricular activities, and trying to find time to just relax. Our hectic schedules can make it very easy to lose sight of the world outside of college, including changes that are occurring within the field of medicine. As these changes will affect many of our lives in the near future, it is essential that we start educating ourselves about these developments. This was one of the fundamental reasons why we created the Medical Decoder. It is our belief that this journal will serve as a location where details of current trends in healthcare are updated and thereby address the needs for students who wish to actively engage with the ongoing changes in the medical field. However, this journal will act not only as a medium from which to learn about important developments within the realm of health care, but also as a source of articles that will be relevant to any pre-medical student. Herein lies the meaning behind the name: the Medical Decoder. The MD is meant to be a means of helping students interested in learning more about medicine sort through all of the esoteric material that is out there. By providing students with a condensed, reader-friendly option for educating themselves and “decoding” all the information regarding advancements in medicine, we hope to facilitate the development of students empowered with diverse knowledge to make them better leaders and doctors in the future. Notably, the topics presented within this journal come from the viewpoints of premedical students, but given that the changes to the medical care system will affect all of us, the topics discussed within this journal are not exclusively limited to future health care providers. On behalf of Phi Delta Epsilon IL Gamma, we would like to welcome you to the inaugural edition of the MD.
Editor In Chief Adtiya Ghosh
Editor In Chief Savan Patel
Associate Editors Alex Pezeshki Aakash Shah Arpan Patel Anthony Angueira Devora Isseroff
Creative Director Hannah Levitan
Associate Creative Director Sarah Smith
Contributing Writers Alex Pezeshki Dani Alcorn Krish Suresh Nirali Shah Sarah Smith Savan Patel Zach Snow
Aditya Ghosh & Savan Patel Co-Founders Chief Editors
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SCRUBS AND ONLINE PHYSICIAN RATINGS BY KRISH SURESH Remember that episode of Scrubs where Dr. Kelso signs the hospital up for a doctor rating website? If you don’t, 1) watch it, it’s hilarious, but 2) here’s a rundown of the episode.
Dr. Kelso, the hospital’s Chief of Medicine, signs the hospital up for a scheme where patients rate their doctors and doctors are ranked accordingly. This leads to a furious competition between the doctors where they resort to devious tricks to fix the rankings (like getting Todd, a perverted resident, to tell his patients he’s J.D., the main character, so that J.D.’s ranking goes down). However, after this trick is discovered, J.D. ends up #1 much to the chagrin of the other doctors.
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This episode illustrates a service that’s been around for a while now, but is ripe for change: online physician ratings. Physician ratyou decide where to go for medical care. However, online physician ratings can get messy. In this article, we’ll explore some of the problems with online physician ratings, then conclude with a brief look at some alternate systems. A big problem with online phy-
sician ratings is the ever-growing number of physician rating sites. Different patients go to one of many sites to rate their doctors, so J.D.’s rating on RateYourDoc.org would come from just 2.4 patient reviews on average.1 Therefore, one strong review significantly affects a rating, meaning a physician’s rating on each of many sites is commonly polarized. This leads to a confusing mix of inforsite would give J.D. 5 stars whereas another would give him 1 1/2 (poor J.D. would be heartbroken). Another problem with online physician ratings is they don’t represent a physician’s entire patient population. Only 3 percent of patients post reviews of their physicians online.2 Though online physician ratrecent study found that 86 percent of a sample of 500 urologists sicians are skeptical and frustrat-
ed with them, considering them nothing more than a popularity contest (as we saw in Scrubs).1,3 In fact, only 39 percent of doctors agree with their ratings.3 The good news for these physicians is that less than one-fifth of patients consult online ratings.2 Accordingly, many physicians believe that online ratings do not significantly affect them.3 Online physician ratings remain a problem, and an improved system would be useful. Better systems exist for use by physicians organizational rating systems that physicians trust.3 Unfortunately, those ratings are not available to patients. Many people realize the need for an accessible, accurate ratings system and are working on creating one. “Health care report cards” are a prominent example of one of these systems. These report the patient health outcomes of health care providers to the public. For
example, you could compare several Chicago hospitals’ success rates of cardiac surgeries, and make your decision on where to go for your cardiac surgery accordingly. Report cards seem like a good system since they’re based on cold, hard data, but one study found that they actually decreased overall patient welfare. Why? Report cards discouraged providers from taking on harder cases. Providers would take on easier cardiac surgeries so that the success rate of cardiac surgery from that provider would be higher on report cards. This made it extremely hard for high-risk patients to get care.4 There are many other studies working on finding systems to evaluate health care providers. One quirkier one found a correlation between the quality of a hospital and the number of likes it had on Facebook!5 Overall, though, no systems to replace online physician ratings have gained much traction yet. For now, the old-fashioned method of asking your friends who the best doctor in town is may be your best bet for a reliable physician rating. The Internet could lead you astray.
References 1) Ellimoottil, C., Hart, A., Greco, K., Quek, M., Farooq, A. (2012, December 7). Online Review of 500 Urologists. 2) Fox, S., Duggan, M. (2013, January 15). One in three American adults have gone online to figure out a medical condition. 3) Johnson, C. (2013, January 16). ACPE Survey Finds Most Physician Leaders Skeptical of Online Ratings. 4) Dranove, D., Kessler, D., McClellan, M., Satterthwaite, M. (2003, May 20). Is More Information Better? The Effects of ‘Report Cards’ on Health Care Providers. 5) Timian, A., Rupcic, S., Kachnowski, S., Luisi, P. (2013, February 1). Do Patients “Like” Good Care? Measuring Hospital Quality via Facebook.
The number of online physician review websites with conflicting reports can make it difficult to accurately gauge the ability of a physician. HTTP://WWW.HEALTHGRADES.COM
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BEING PRE-MED THE HIGHS, THE LOWS, AND EVERYTHING IN BETWEEN BY: DANI ALCORN Four years ago a friend loaned me a
ings of inferiority, extreme sleep depriva-
book called, “Another Day In The Frontal
tion, and an inability to carry on a normal
Lobe,” a neurosurgeon’s memoir. One after-
noon, I started reading it. Twenty-four
There’s not much you can do about
hours later I knew what I wanted to do
over-analyzing the world. The classes you
with my life. Twenty-four hours after that,
take as a pre-med student will work their
I changed my major.
way inside your brain and change the way
I still remember the excitement of that
you see the world. A biochemistry profes-
seventeen-year-old me, as I turned each
sor told me that when he looks at a tree
page and realized how right that career
all he sees are hydrogen bonds. He wasn’t
felt. What I didn’t realize was the reality
exaggerating. When I look at a glass of
of being pre-med. I wish someone had
orange juice, I no longer see a refreshing
told me what to expect once I committed
beverage; I see a cup full of glucose, and
myself to that journey. So now, after four
know it’s the fastest way to feed my cel-
years navigating by trial and error, I’m here
lular metabolism, generating ATP for my
to tell you.
brain to burn through during a big exam.
No one who goes into pre-med expects
Once you start seeing chemical bonds
it to be easy. Being pre-med is one of the
hardest things you’ll ever do, academically
where, the only thing you can do is learn
ment produced was my biggest challenge
and emotionally. It can be worth it, but you
to filter out those observations when
as a pre-med student. It was definitely a
should go in with your eyes open.
you’re around your non-pre-med friends
two steps forward one step back battle for
So what does being pre-med mean? Nam ut massa If you ask the pre-med advisors, as I did, they’ll tell you means taking a set of turpis, acit blandit required science classes, research and volunteer the MCAT. To me justo.experience, Nulla and ultrithat’s a lousy answer. ces, comThoseodio are the things you do when you’re pre-med. What being pre-med means is modo faucibus fundamentally changing the way you think. commodo, mi nisi If being pre-med came with a warning tempor” label, this is what it would say: Caution!
to avoid driving them crazy. It takes a little
me, but eventually I did it. Based on that
bit of practice, but eventually you get the
experience, here is the advice I offer:
Side effects may include over-analytic tendencies, increased neuroticism, feel-
coefficients of static friction every-
hang of it.
Find something you love. Hold onto
The neuroticism and inferiority com-
it. For me, it was psychology research. I
plex come into play because of the way
started working in a lab studying things
almost all pre-med classes are graded:
I thought were fascinating with a mentor
on a curve. Aside from the hit to your ego
who encouraged me to ask good ques-
a 54% can cause, this often places you in
tions and start a project of my own. It
the uncomfortable position where you’re
forced me to take a break from my pre-
simply trying to do just a little bit better
med studies and do something I enjoy and
than everyone else, which can create a
find fulfilling. It also gave me perspective:
cutthroat atmosphere and diminish the
there’s more to life than biology exams.
desire to learn for learning’s sake.
The thing you love could be anything:
Overcoming the anxiety this environ-
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research, painting, writing, movies, his-
torical reenactment... You probably already know what you love.
that I sat down and made a four year plan right after I decided
Don’t let being pre-med take you away from it. If you don’t know
to be a doctor. I had every single class for every single quarter of
what you love yet, take some random classes and find out!
college planned out. When I look at that document now I have to
Make pre-med friends. Don’t try to go this alone. You need
laugh. I deviated from “the plan” so many times it’s unrecogniz-
someone who understands what you’re going through and the
able. In the beginning, every time I wanted or needed to change
pressure you’re under. Sometimes you just need a pep talk from a
something I suffered a major anxiety attack, because deviating
friend who’s been where you are. Also, sometimes being the one
from “the plan” seemed like failure or defeat. It wasn’t. Sure, you
giving the pep talk is even more effective at keeping your spirits
need a general idea of where you’re going; but leave yourself
up. We’re pre-med, we like helping people.
room to grow, explore, and discover new interests.
Make non-pre-med friends. You need people to balance out
Know your limits. Unfortunately, the only way to learn them is
your life and give you some perspective. If you let your world-
the hard way. But once you find them, stop piling on more com-
view collapse into a tiny point centered around organic chem-
mitments. It’s better to do a few things exceptionally than a lot
istry or physics, you’ll make yourself miserable. Hanging out
of things haphazardly. Life isn’t a race and there are no points for
with friends who aren’t pre-med will remind you life outside the
finishing early. Completing your basic sciences in two years isn’t
classroom/lab/textbook still exists.
worth it if it leaves you so academically and emotionally tapped
Don’t get tunnel vision. My biggest mistake being pre-med was
out you can’t function.
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And I knew someday that was going to be me. It doesn’t get much better than that.
Being Pre-Med cont’d Ask for help. Ask professors, TAs, friends, parents, siblings, whoever, if you need help, academically or emotionally. This is hard stuff and there is no shame in needing office hours, a tutor, or simply a shoulder to lean on. Bottling things up only puts off the inevitable moment when you have to deal with everything. As someone who wants to be a doctor someday, prioritize your mental and physical health. Being pre-med was a terrifying and overwhelming, but also incredible and inspiring experience, despite the pitfalls. For every moment I thought I couldn’t possibly make it through another week, there was a moment I was reminded why I thought this was a good idea in the first place. If being pre-med came with a list of effects, here’s what it would say: Being pre-med will lead to a lifelong, fulfilling career, cause you to understand how the world works, and may induce feelings of euphoria when you realize you will someday have the skills to save lives. I watched a neurosurgeon perform a craniotomy and remove a tumor the size of a golfball. I was in a room, four feet away from a real-live-honest-to-God brain, watching a doctor save a patient’s life. And I knew that someday that was going to be me. It doesn’t get much better than that. When I’m stressed out and unsure if I made the right decision, that’s the moment I think back to. Was the rest of it worth that moment? I think so. The question you must answer is, do you?
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SHARED SAVINGS, SHARED PROGRESS?
THE NEW MEDICAL CARE SYSTEMS IN OUR COUNTRY BY: SAVAN PATEL Arguably more so than any other recent cornerstone of
tor—if an ACO saves money in providing for a patient, it shares
reformation, the passage of the 2010 Patient Protection and
in the savings.5 Contextually, savings are defined compared to a
Affordable Care Act (ACA) in 2010 has sparked much debate.
benchmark set by the Centers for Medicare & Medicaid Services
Making sense of ObamaCare is no small task. As future health
(CMS) relative to the cost of treating a certain type of patient.6
care workers, however, we are obligated to familiarize ourselves
For example, let us assume that CMS declares treating a certain
with the dynamic system we all aspire to join. One of the fun-
patient should incur some cost X. If an ACO effectively treats
damental changes we will see in the coming years is a direct
the patient in question with a total expense less than X, then
attempt to stunt the rising cost of providing healthcare services.
said ACO shares in the savings obtained. However, if the same
Naturally, services themselves are inseparable from reimburse-
ACO treats the very same patient at a cost that eventually sur-
ment. Below, you’ll find a few of the mechanisms through
passes X, then they will in fact be penalized and forced to make
which the ACA will innately change the rules of medical care
up the difference out of their own pocket. Theoretically, the
reimbursement: Accountable Care Organizations (ACO’s) and
motivation here is clear—if an ACO is able to provide effective
care at a lower cost, they will reap the monetary reward.
Past criticisms of the American healthcare system were
Ultimately, the $1.1 trillion ACA price tag is indicative of the
rooted in its dispersed and decentralized organization. In other
ambitious investment the U.S. has made in order to reform our
words, no single party could be held responsible for the care
healthcare system.7 While the law no doubt boasts many tech-
of a single patient. The result was thought to be as follows:
nical nuances, the above model is a broader mechanism that
segmentation leads to waste, and waste leads to high costs.
aims to cut costs and lower healthcare expenses—arguably, two
Accountable Care Organizations are the hopeful solution.1 By
of the greatest challenges the ACA hopes to overcome.
definition, an ACO is a “provider-led organization whose mission is to manage the full continuum of care and be accountable for
1) Berwick, Donald M. (2011). “Launching Accountable Care Organizations—The Proposed Rule for the Medicare Shared Savings Program.” New England Journal of Medicine, 364(16), e32. DOI: 10.1056/NEJMp1103602.
To provide context, recently approved ACOs range from private
2) Rittenhouse, D. R., et al. (2009). “Primary Care and Accountable Care — Two Essential Elements of Delivery-System Reform.” New England Journal of Medicine, 361(24): 2301-2303. DOI: 10.1056/NEJMp0909327.
organizations similar to the Steward Health Care System in
3) Corbett, J. Kappagoda, M. (2013). “Doing good and doing well: corporate social responsibility in post obamacare america.” Journal of Law, Medicine, & Ethics, 41(1): 17-21. DOI: 10.1111/jlme.12032.
the overall costs and quality of care for a defined population.”
Massachusetts, to large academic centers such as the University of Michigan.3,4 While such a definition may seem vague, the true importance of an ACO can be seen in context of the idea of shared savings. The Medicare Shared Savings Program is an apt self-descrip-
4) Peskin, S. R. (2012). “New Care Delivery Models: Where Do Biologics Fit?” Biotechnology Healthcare, 9(2): 19-20. 5) Berwick, Donald M. (2011). “Making Good on ACO’s Promise—The Final Rule for the Medicare Shared Savings Program.” New England Journal of Medicine, 365(19): 1753-1756. DOI: 10.1056/NEJMp1111671 6) ”Accountable Care Organizations: Improving Care Coordination for People with Medicare.” Healthcare.gov. U.S. Department of Health & Human Services, 31 Mar. 2011. Web. 31 Mar. 2013. <http://www.healthcare.gov/news/ factsheets/2011/03/accountablecare03312011a.html>. 7) Congressional Budget Office, Updated Estimates for the Insurance Coverage Provisions of the Affordable Care Act (March 2012), p. 1.
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WE ARE YOUNG.
THE RESILIENCE OF THE HUMAN BODY IN THE FACE OF YOUTHFUL INDISCRETION
BY: ZACH SNOW he social scene at the collegiate level is perhaps one
actions. How is this possible?
of the most remarkable displays of youth, immunity,
The answer to this question lies within the astonishing
and the amazing capabilities of the human body. A
resilience of the young human body. The Journal of Studies
recent study by O’Malley and Johnston reveals that
on Alcohol and Drugs reports that amongst Americans ages
nearly two-thirds of all college students have reported drink-
15-19, 42.7% of deaths are alcohol related compared to 47.2%
ing over the last month. Of these students, more than half
in the 45 to 54 years age group.4 These statistics ultimately
have engaged in binge drinking (consuming five or more
reflect the complex relationship between the effectiveness of
drinks in one sitting for males and four or more drinks in one
the body’s metabolic enzymes in preventing alcohol-induced
sitting for females) within the past two weeks. The Centers
permanent tissue damage and age. The advantage of youth
for Disease Control (CDC) reports that 80,000 people die from
similarly plays into effect in smoking related casualties.
binge drinking each year in the U.S. alone.2 This exceeds the
The Journal of the American Medical Association reports
number of fatalities from gunshot wounds (30,000 a year),
that approximately 46% of all college students use tobacco
motor vehicle accidents (40,000 a year), and animal-related
products such as cigarettes.5 Astonishingly however, The New
attacks (180 a year) combined. Still, the Journal of Drug
England Journal of Medicine published a study in 2013, claim-
Education cites that college students in the U.S. consume an
ing that quitting before the age of forty can regain nearly a
estimated 430 million gallons of alcohol a year. With such
decade of living otherwise lost to smoking.6 And while the
a high incidence of alcohol-related mortality, the stagger-
National Institute on Drug Abuse reports that drug use is high-
ing amount of college students that are willing to take this
est amongst people in their late teens and twenties, a study
dangerous risk for the sake of a good time is dumbfounding.
by scientists at Britain’s Medical Research Council found that
Yet somehow, we usually will avoid the morbid results of our
older drug abusers are two to six times more likely to die than
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The truth is that youth plays an extraordinary role in defending students from the noxious byproducts of an active social life during college.
levels of welfare dependence, increased rates of unemploy-
The truth is that youth
ment, and lower levels of satisfaction, all by the age 25.10
plays an extraordinary
Ultimately, the college social scene conveys the remark-
role in defending stu-
able ability of young people to withstand the fatal conse-
dents from the noxious
quences of substance abuse, be it drugs, alcohol, or cigarettes.
byproducts of an active
However, with the power of relative immunity comes the
social life during col-
responsibility of protecting such an advantage. Addiction can
lege. From an evolu-
destroy lives. In socializing, moderation can be one of the
tionary standpoint, the
best defenses against falling under the influence. College is
indeed one of the most unique social settings in a person’s
of an undergraduate’s
life, but with proper education regarding age-dependent
limits, we can ensure bright futures are made and not broken.
intellectual immaturity and recklessness synonymous with young people.
Despite these auspicious statistics, college students xneed to understand the dangers of a hyperactive social life. A study by Porter and Pryor in 2007 exposes the negative relationship
References 1) O’Malley, P., & Johnston, L. (2002). Epidemology of Alcohol and Other Drug Use Among American College Students. J. Stud Alcohol Suppl: 3(14), 23-39. 2) Center for Disease Control and Prevention. (2012). Vital Signs: Binge Drinking. Retrieved March 10, 2013, from http://www.cdc.gov/vitalsigns 3) Boyle, P., & Boekeloo, B. (2009). The Association Between Parent Communication and College Freshmen’s Alcohol Use. J. of Drug Education: 39(2), 113-131. 4) Rasul, J., Rommel R., Jacquez, G. (2011). Heavy Episodic Drinking on College Campuses: Does Changing the Legal Drinking Age? J. of Studies on Alcohol and Drugs: 72(1), 15-23. 5) Brent, J. (2010). Tobacco or Health? Physiological and Social Damages Caused by tobacco Smoking. J. of the American Medical Association: 304(21), 2419. 6) Vastag, B. (2013, January 23). Quitting Smoking by Age 40 Erases Most of the Risk of an Early Death. The Washington Post.
between heavy episodic alcohol use and time students allo-
7)The National Institute on Drug Abuse. (2011). Topics in Brief: Prescription Drug Abuse. Retrieved March 10, 2013,
cated to academics.9 Research at the University of Otago in
8) Berg, A., & Shinnar, S. (2010). Relapse Following Discontinuation of Antieleptic Drugs: A meta-analysis. Britain’s
New Zealand documented in 2008 that higher levels of can-
9) Porter, S., & Pryor, J. (2007). The Effects of Heavy Episodic Use on Student Engagement, Academic Performance,
nabis use between the ages of 14-21 correlated with lower levels of degree attainment, reduced annual incomes, higher
http://www.drugabuse.gov/publications/topics-in-brief/prescription-drug-abuse Medical Research Counsel: 11(32), 601-608. and Time Use. Journal of College Student Development: 48(4), 455-467. 10) Boden J., & Fergusson D. (2011). The Short and Longterm Consequences of Adolescent Alcohol Use. In: Young People and Alcohol: Impact, Policy, Prevention and Treatment. J Saunders and JM Rey (Eds). Chichester, Wiley-Blackwell. 32- 46.
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MEDICAL SCHOOL CURRICULUMS TURNING OVER A NEW LEAF BY NIRALI SHAH
ith the ever-changing dynamics of the medical field, faculty and students at medical schools across the nation are quickly realizing that it is time to switch gears. As a result, over the past few
decades, a market shift has taken place in the experience of the typical medical student. Medical schools have dramatically altered their curriculums in order to make the unwieldy learning process more efficient, enjoyable, and applicable for medical students. Top medical schools—like New York University, Emory, Stanford, and Northwestern—have devoted years of research towards improving the experience of their students.1,2,3,4 What have they learned? Get students into the hospitals sooner. Giving medical students the ability to spend one-on-one time with patients as early as their Medical 1 (M1) year requires young students to hone their “bedside manner” before they have even had time to crack open a textbook. To prepare medical students for reallife patient experiences, some schools have students spend a couple hours a week practicing medical examinations with standardized patients. These “patients” are actually paid actors who present a certain series of symptoms to medical students, just as any real patient would. In addition to patient simulations, several schools have instituted a new curriculum requiring students to commit time to being part of a core medical team at a local hospital clinic.5,6 In these programs, students are placed into small groups with their peers and assigned a preceptor with whom they will spend the next four years practicing patient skills and general professionalism in a real-life outpatient setting. Medical schools hope these practices will teach students the level of compassion, advocacy, responsibility, and empathy that are vital to becoming successful physicians. Along with a focus on communication and people skills, the changing curriculum expects medical students to become more independent in their academic preparation for residency.7 A linear
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more independent in their academic 7
What better teacher for students than the
preparation for residency. A linear path
students themselves? The PBL strategy
towards achieving an MD degree via two
allows students to work together to solve
years of classroom work and two years
a scenario or patient diagnosis.10 There is
of early morning rounds is not sufficient
no formal advisor present during these
in preparing them for the ever-changing
sessions, allowing students to feel com-
lifestyle of a 21st century physician.
fortable conceding they may not know
Instead, students are expected to decide
the answer. Additionally, it provides stu-
an area of scholarly concentration—sim-
dents the opportunity to take ownership
ilar to an undergraduate major—dur-
of group learning. In addition to solving
ing their first year.8,9 Depending on the
applicable problems, these PBL sessions
individual school’s curriculum, this con-
allow students to get to know each other
centration can range from translational
more than they ever would in a lecture-
medicine to medical humanities and eth-
style environment. Often, students that
ics. Within their first year of medical
meet through PBL groups have formed
school, students choose a mentor for
study and social groups outside of their
their individual project, which will even-
weekly sessions to review material or
tually lead up to a thesis during their
vent about the overwhelming schedules
fourth year. Between the time a mentor is
they are trying to adapt to.
Giving medical students the ability to spend one-on-one time with patients as early as their Medical 1 (M1) year requires young students to hone their “bedside manner” before they have even had time to crack open a textbook.
chosen and the time they decide their top
Some schools have a much more
three match choices, students develop a
drastic new curriculum than others, but
clinical research project that encompass-
the three main aspects that all “new age”
es their area of concentration. Depending
institutions have adopted are: long-term
on the field, students can make use of
clinical exposure, areas of scholarly con-
community health clerkships, unsched-
centration, and PBL. Advocates of these
uled weeks, or even their M4 elective
changed curriculums hope that they are
course to complete the clinical research
providing for an easier, more effective
and written manuscript required for their
way to educate students. The hope is
1) Curriculum for the 21st century. (2013). Retrieved April
that these early experiences will help
3, 2013, from
The final aspect of the new curricu-
students understand the importance of
2) MD Curriculum. (2013). Retrieved April 3, 2013, from http://
lum medical schools across the nation
core competencies necessary to become
3) New Curriculum at Feinberg. (2012). Retrieved February
are successfully transitioning to is the
effective and compassionate physicians.
problem-based learning (PBL) strategy.
med.emory.edu/education/curriculum/md/index.html 20, 2013, from http://www.feinberg.northwestern.edu/educa4) Overview of the MD Curriculum. (2013). Retrieved April 3, 2013, from http://med.stanford.edu/md/curriculum/overview.html 5) Education-4-CARE Associates Program. (2013). Retrieved April 2, 2013, from http://med.stanford.edu/e4c/associatesprogram.html 6) Education Centered Medical Home. (2013). Retrieved April
A linear path towards achieving an MD degree via two years of classroom work and two years of early morning rounds is not sufficient in preparing them for the ever-changing lifestyle of a 21st century physician.
2, 2013, from http://www.feinberg.northwestern.edu/education/curriculum/learning-strategies/education-centeredmedical-home/index.html 7) K. Unti, personal communication, February 26, 2013 8) Scholarly Concentration Program. (2013). Retrieved April 3, 2013, from http://brown.edu/academics/medical/education/ scholarly-concentration-program 9) Area of Scholarly Concentration Program. (2012). Retrieved April 3, 2013, from http://www.feinberg.northwestern.edu/ admissions/pdfs/Scholarly-Concentration-Program.pdf 10) S. Shah, personal communication, February 26, 2013 11) Integrating Scholarly Concentration Work into Clinical Years. (2013). Retrieved April 3, 2013, from http://brown. edu/academics/medical/integrating-scholarly-concentrationwork-clinical-years 12) Problem Based Learning Curriculum a Success for Medical Schools. (2006). Retrieved April 2, 2013, from http://www. medicalnewstoday.com/releases/55419.php
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GIVING VOICES TO THE VOICELESS: ADDRESSING THE ISSUES OF HEALTH LITERACY IN IMMIGRANT POPULATIONS
BY: ALEX PEZESHKI What is Health Literacy and Why Should We Care? The ability to live a healthy life is a salient issue in today’s
Furthermore, immigrant populations, particularly those in
world, particularly for immigrant populations: the effects of a
low and middle-income countries, are incredibly vulnerable to
country having immigrants who are ill, whether mentally or
health disparities and serious diseases: among the most vulner-
physically, can be detrimental to the population as a whole.
able group of individuals in the United States today for cancer-
Health literacy, which can be defined as the ability of an
related health disparities, immigrants also exhibit greater risk
individual to “obtain, process, and understand basic health infor-
for heart attacks, diabetes, strokes, and HIV/AIDS.2 Knowing that
mation and services,” plays a critical role in the health status
these populations suffer disproportionately from such diseases,
of these populations. Since health literacy refers to an indi-
the necessity to address the issue of health literacy becomes
vidual’s ability to apply health information in a specific health
even more of an imperative.
care environment, having low health literacy is problematic
It is truly unfortunate that the resources being allocated to
because it creates difficulties in obtaining health care services.
improve the ability of immigrants to obtain, process, and under-
Considering the rise in immigrant growth, the issue of health
stand basic health information and services are severely limited.
literacy in immigrant populations is one that must be addressed
The American Public Health Association has passionately argued
that a lack of investment in ways that would promote health
What is the Context of the Problem Today?
literacy would cost the US billions of dollars in unnecessary medical expenses. Moreover, difficulties in understanding and
When we consider the fact that many of these immigrants
using health information are not something limited to only
have to overcome language barriers and have feelings of loneli-
immigrant populations: nearly half of all adult Americans report
ness as they are separated from their family, we come to realize
that the challenges of adapting to a new society only exacerbate the problems stemming from low health literacy. 26% of participants in a Latino immigrant study reported depressive symptoms brought about by stressors involved in adapting to a new society, including low health literacy.1
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What Can We Do to Address the Issue? In order to improve the current state of health literacy, more research needs to be done in order to close the current gaps in knowledge about the ways in which immigrant populations use
health care services; by taking a closer look at their learning
a patient’s willingness to do what the doctor has.5 The afore-
practices and ways of navigatinwg through myriad services, for
mentioned policies must, therefore, be sensitive to culturally
instance, steps can be taken to knowing more about the current
relevant, accurate, and timely health information.6
state of health literacy so that it may then be improved upon.4
Finally, at the heart of any recommended solution lies clear
If policies are to be effective, they must transcend the boundar-
communication. By creating a welcoming atmosphere and
ies of geography, race, gender, age, and socio-economic status.
asking patients what they need while being sensitive to their
The following are solutions that have been proposed to address the issue:
cultural belief system, these proposed solutions will be both effective and long-lasting.
• Developing a closer interaction between the health care system and immigrant-serving agencies. • Including literacy profiles and language preferences directly within the medical files of these individuals.
References Latino Immigrants.” Home Health Care Management & Practice 22.2 (2010): 116-22. SAGE Journals Online. Web. 20 Oct. 2012. <http://hhc.sagepub.com.turing.library.northwestern.edu/content/22/2/116.full.pdf+html>.
• Teaching undergraduates and graduates who are currently enrolled in health programs more about cultural competency and the issues surrounding health literacy, thereby developing a broader national vision of a more health liter 4
Innovative solutions like renewing the collaborative practice,
2) Gary L. Kreps, Lisa Sparks, Meeting the health literacy needs of immigrant populations, Patient Education and Counseling, Volume 71, Issue 3, June 2008, Pages 328-332, ISSN 0738-3991, 10.1016/j.pec.2008.03.001. http://www. sciencedirect.com/science/article/pii/S0738399108001328 3) Krisberg, Kim. “Apha Advocates.” Nation’s Health 38.1 (2008): 2. MAS Ultra - School Edition. Web. 8 Nov. 2012. http:// web.ebscohost.com/ehost/detail?sid=89527871-ba91-4e6a-9287- 653877c8c943%40sessionmgr14&vid=1&hid=1 5&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=ulh&AN=30002300 4) Zanchetta, Margareth S., and Iraj M. Poureslami. “Health Literacy Within the Reality of Immigrants’ Culture and Language.” Canadian Journal of Public Health 97 (2006): 26-30. http://www.douglas.bc.ca/__shared/assets/
which involves gathering together efforts from practitioners,
policy-makers, researchers, key informants, and opinion leaders
5) Shaw, Susan, and Cristina Huebner. “The Role of Culture in Health Literacy and Chronic Disease Screening and
in communities, can ultimately aid in combating the issue.
In attacking the issue of health literacy, however, it is important to address the often forgotten issue of cultural beliefs
Management.” Journal of Immigrant Minority Health (2008). http://anthropology.arizona.edu/sites/anthropology. arizona.edu/files/u3/Shaw%20et%20al_JIMH_new.pdf’ 6) Gary L. Kreps, Lisa Sparks, Meeting the health literacy needs of immigrant populations, Patient Education and Counseling, Volume 71, Issue 3, June 2008, Pages 328-332, ISSN 0738-3991, 10.1016/j.pec.2008.03.001. http://www. sciencedirect.com/science/article/pii/S0738399108001328
revolving around health and illness as they, too, contribute to
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THE MCAT AS A MIRROR REDEFINING THE IDEAL PHYSICIAN BY: SARAH SMITH
ost of us have likely heard the buzz about the new MCAT.
If you heard about it and googled it as I did a year ago, you would read that the new MCAT will include two new sections: “Psychological, Social, and Biological Foundations of Behavior” and “Critical Analysis and Reasoning Skills,” in addition to a “revamped” version of the two natural science sections. The new MCAT will “require aspiring doctors to have an understanding of the social and behavioral sciences, in addition to a solid background in the natural sciences.”1 But what does this actually mean for pre-med students? Medical schools have re-designed the “raw material that [they] receive to mold into the nation’s future doctors” to focus more heavily on social and behavioral factors that influence health.2 This means bioethics, psych, sociology; this means that taking humanities classes as a pre-med undergraduate student might actually help you do well on the MCAT. In fact, pre-med curriculums may come to require these courses. The new MCAT is not just a new exam, but rather, a statement about what qualities will constitute the ideal doctor of the future.
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When I first read about the new MCAT, many questions popped into my head. Why is the image of the ideal doctor being redefined now? Who is this ideal doctor of the future? And what can I do to prepare myself not only for the new MCAT but, more importantly, for the change in medical education that it reflects? These are the questions that lay the foundation for the shift towards the new MCAT, and these are the questions that every pre-med should be asking when choosing the path of medicine.
WHY NOW? The globalization of health is a major factor influencing the new image of the ideal doctor. Historically, the health sector has been closed and nationally focused. In recent years, as the world has become more interconnected, health issues have begun to transcend borders, and countries have begun to experience overlapping health issues like “dengue, influenza A, and HIV” along with transnational determinates such as “climate change or urbanization.” 3 The globalization of the health sector has allowed world health organizations and individuals to compare and contrast
attempt by medical schools to send out a clear message to
medicine and medical practices across the world. Globalization
their future physicians: medicine is about more than straight
of health care led those in the medical field to realize that
sciences, and new criteria will be used to judge your value as
health is not just a matter of biological systems, but rather,
inextricably linked with social and behavioral factors. Even on
PREPARE FOR CHANGE
a micro-scale, the domestic rise in obesity, diabetes, and heart disease has demonstrated the tight relationship between health and the social context. These are new diseases, and future physi-
For pre-meds taking the MCAT in 2015 or later, the new MCAT
cians need to understand them beyond pure pathology and biol-
should not just mean choosing a different test prep course. The
ogy. The rise of globalized medicine and the idea that medicine
new MCAT is a symbol of the dynamic nature of the field of
and health care must look beyond the biological into social and
medicine and the direction in which it is shifting. While extra
behavioral factors are relatively novel, but are largely respon-
humanities classes may feel burdensome in the short run, they
sible for the re-defined image of the ideal doctor.
are providing us with unique opportunities to educate ourselves in fields, such as psychology, global health, and sociology, that
THE IDEAL DOCTOR The ideal doctor of the future is equipped to face medicine not only as a natural science, but as a social and behavioral science as well. He/she understands the ethical implications of the constantly advancing technology used in medicine and is ready to take on the major controversies surrounding it. The ideal doctor looks beyond the clinical experience and pathology to the social and behavioral context of the patient’s life, because he/she knows that health is inextricably linked to the
will make us better physicians with improved bedside manners. We can prepare for the new MCAT by taking classes that help us understand the effects of socioeconomics on health, the ethical dilemmas behind biomedical technology, the psychological factors that influence patient decisions: classes that train us to be socially aware. This is the direction that the medical field is heading, and as pre-med students, we have a lot to look forward to. References 1) Mann S. AAMC Approves New MCAT® Exam With Increased Focus on Social, Behavioral Sciences. Rep. Association
social context. This is the type of doctor that we, as pre-meds,
of American Medical Colleges,Mar.2012.online. <https://www.aamc.org/newsroom/reporter/march2012/276588/
should strive to be.
The modern physician not only needs a firm understanding
2) Rosenthal E. Pre-Med’s New Priorities- Heart and Soul and Social Science. New York Times 15 Apr. 2012: n. pag. Print.
of natural sciences, pathology, and biology, but also, and per-
3) Koplan JP, Bond TC, Merson MH, Reddy KS, Rodriguez MH, Sewankambo NK, Wasserheit JN for the Consortium
haps more importantly, requires a true understanding of human
of Universities for Global Health Executive Board. Towards a common definition of global health. The Lancet
psychology and behavior. It is the combination of the two that
defines the modern practice of medicine. The new MCAT is an
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THE MD TEAM
TOP ROW ( FROM LEFT TO RIGHT ): ADITYA GHOSH, ARPAN PATEL, SAVAN PATEL, ALEX PEZESHKI, KRISH SURESH, ANTHONY ANGUEIRA, AAKASH SHAH, ZACH SNOW BOTTOM ROW ( FROM LEFT TO RIGHT ): DANI ALCORN, SARAH SMITH, NIRALI SHAH, DEVORA ISSEROFF NOT PICTURED HANNAH LEVITAN
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